Individual
MRS. JACQUELINE SUMPTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
8500 BROADWAY STE H, MERRILLVILLE, IN 46410-7006
(219) 769-7758
Mailing address
611 W 47TH AVE, GARY, IN 46408-4542
(219) 682-6266
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
27054773A
IN
Other
Enumeration date
09/08/2022
Last updated
09/08/2022
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